Images in clinical medicine | Volume 39, Article 156, 29 Jun 2021 | 10.11604/pamj.2021.39.156.11232

Cranial nerve IV palsy after mild head trauma: a rare image

Hassen Ben Ghezala

Corresponding author: Hassen Ben Ghezala, Service Universitaire des Urgences et de Réanimation Médicale, Hôpital Régional de Zaghouan, Faculté de médecine de Tunis, Tunis, Tunisie

Received: 21 Nov 2016 - Accepted: 19 Feb 2017 - Published: 29 Jun 2021

Domain: Clinical medicine

Keywords: Trochlear nerve, palsy, brain injury, trauma

©Hassen Ben Ghezala et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Hassen Ben Ghezala et al. Cranial nerve IV palsy after mild head trauma: a rare image. Pan African Medical Journal. 2021;39:156. [doi: 10.11604/pamj.2021.39.156.11232]

Available online at: https://www.panafrican-med-journal.com/content/article/39/156/full

Home | Volume 39 | Article number 156

Images in clinical medicine

Cranial nerve IV palsy after mild head trauma: a rare image

Cranial nerve IV palsy after mild head trauma: a rare image

Hassen Ben Ghezala1,&

 

1Service Universitaire des Urgences et de Réanimation Médicale, Hôpital Régional de Zaghouan, Faculté de Médecine de Tunis, Tunis, Tunisie

 

 

&Corresponding author
Hassen Ben Ghezala, Service Universitaire des Urgences et de Réanimation Médicale, Hôpital Régional de Zaghouan, Faculté de médecine de Tunis, Tunis, Tunisie

 

 

Image in medicine    Down

Mild traumatic brain injury is characterized by a Glasgow coma scale GCS between 13 and 15. It is a frequent pathology in our country because of the increasing number of circulation accidents. Trauma-induced superior oblique palsy usually results from contusion or avulsion of the trochlear nerve. Severe craniocerebral trauma is often associated with the former mechanism, whereas more minor closed-head injuries can decompensate a congenital phoria. We report a patient who developed an isolated trochlear nerve palsy following minor head trauma. Our 53 years-old patient without significant past medical history was victim of a traffic accident. He presented with a complaint of diplopia following head trauma the week prior. He lost consciousness for less than 1 minute. He noticed diplopia immediately upon awakening, but had no other neurologic symptoms. He presented to our emergency department for evaluation. Computed brain tomography (CT) performed did not show any orbital fractures. Ocular exam revealed mild to moderate infraduction deficit and supraduction excess in adduction of the left eye. Left head tilt test was negative. We finally concluded that our patient had a trochlear nerve palsy following the brain trauma. Further Magnetic Resonance Imaging (MRI) revealed an unsuspected tentorial vascular malformation that was compressing the trochlear nerve in its subarachnoid course. In the absence of other features that support decompensation of a congenital trochlear nerve palsy, compressive lesions should be sought in case of fourth cranial nerve palsy following head trauma.

 

 

Figure 1: paralysis of adduction of the left eye

 

 

 

 

Images in clinical medicine

Cranial nerve IV palsy after mild head trauma: a rare image

Images in clinical medicine

Cranial nerve IV palsy after mild head trauma: a rare image

Images in clinical medicine

Cranial nerve IV palsy after mild head trauma: a rare image

Volume 40 (Sep - Dec 2021)
This article authors
On Pubmed
On Google Scholar
Citation [Download]
Zotero
EndNote XML
Reference Manager
BibTex
ProCite

Navigate this article
Similar articles in
Key words

Trochlear nerve

Palsy

Brain injury

Trauma

Article metrics
Countries of access